Provider Demographics
NPI:1790149508
Name:PETTINGILL, EMMA E (BCBA)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:E
Last Name:PETTINGILL
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:EMMA
Other - Middle Name:E
Other - Last Name:HENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:11623 ANGUS RD STE E20
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-4003
Mailing Address - Country:US
Mailing Address - Phone:512-827-7011
Mailing Address - Fax:
Practice Address - Street 1:11623 ANGUS RD STE E20
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759
Practice Address - Country:US
Practice Address - Phone:512-827-7011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-07
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-16-21495103K00000X
TX1033103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst